Advanced Exudative Retinopathy with Neovascular Glaucoma as the Clinical Presentation of Diabetes Mellitus and Severe Combined Hyperlipidemia: A Case Report
Suthasinee Sinawat MD*, Sukhumal Thanapaisal MD*, Supat Sinawat MD**
Affiliation : * KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
A 50-year-old man presented with bilateral progressive visual loss for 5 months. Visual acuity was reduced to
counting fingers in the right eye and light perception in the left. Although neovascularizations were detected in the angles of the
eyes, neovascular glaucoma and rubeosis iridis were demonstrated only in the left. Fundus examination showed bilateral
advanced exudative retinopathy in both eyes. Severe attenuated retinal arteries and enlarged cupping with disc pallor were
observed in the left eye. Generalized eruptive xanthomas were found on the back and extremities. Extreme dyslipidemia
(serum cholesterol 1,311 mg/dl and triglycerides 6,356 mg/dl) and diabetes mellitus (fasting plasma glucose 325 mg/dl and
HbA1c 12.1%) were first diagnosed. The serum lipid profiles and glucose levels were dramatically decreased within a month
after treatment with subcutaneous insulin injections and oral hypolipidemic agents; notwithstanding, his vision was not
significantly improved, even after treatment with intravitreal anti-VEGF injection, intravitreal steroid injection and panretinal
photocoagulation.
Conclusion : The principle causes of advanced exudative retinopathy are severe breakdown of the blood-retinal barrier due
to diabetes mellitus and altered retinal pigment epithelium lipid metabolism. In our patient, central retinal vascular occlusion
was also the suspected cause of neovascular glaucoma.
Keywords : Exudative retinopathy, Dyslipidemia, Neovascular glaucoma, Diabetes mellitus
